**2.6 Diagnosis of DR**

*Type 2 Diabetes - From Pathophysiology to Cyber Systems*

Moderate NPDR Microaneurysms + other signs:

*International Classification of Diabetic Retinopathy [57].*

No apparent DR No abnormalities Mild NPDR\* Microaneurysms only

**DR Findings on Dilated Ophthalmoscopy**

• dot and blot hemorrhages

and no signs of proliferative retinopathy

PDR\* Severe non-proliferative DR + one of the followings: Neovascularization Vitreous/preretinal hemorrhage *\*NPDR: non proliferative diabetic retinopathy; \*PDR: proliferative diabetic retinopathy*

• hard exudates cotton wool spots Severe NPDR Moderate NPDR with any of the following:

**2.5 Clinical forms of DR associated with high risk of vision loss**

however, if untreated, it can may to permanent photoreceptor damage.

DME is considered clinically significant if [61–63]:

within 1 disc diameter of the center of macula

of adjacent retina

**Table 1.**

in patients with T2DM.

*2.5.1 Advanced diabetic ocular disease*

tions appear and the vision loss is irreversible.

• located at or within 500 μm of the center of the macula

Diabetic maculopathy is the most frequent cause of decreased vision encountered in patients with T2DM. It can be manifest in every stage of the DR and represents the involvement of the fovea by hard exudates, macular edema due to fluid extravasation or by macular ischemia. In early stages, the loss of vision is mild;

• Intraretinal hemorrhages ≥20 in each quadrant; • Definite venous beading (VB) in 2 quadrants;

• Intraretinal microvascular abnormalities (IRMA) in 1 quadrant;

• hard exudates at or within 500 μm of the center if associated with thickening

• the area of retinal thickening is larger than one optic disc area and is located

Advanced diabetic disease can remain asymptomatic for a long period of time, due to slow proliferation of the retinal neovessels and their location, usually in mid-periphery. It consists of retinal neovessels that grow into elevated fibrovascular membranes that enter the vitreous body, leading to serious complications: vitreous hemorrhage and retinal detachment [62]. Proliferation of the abnormal vessels at the level of iris and iridocorneal angle led to neovascular glaucoma, with poor clinical outcomes. Ophthalmological periodical screening is extremely important in early identifying and referral to laser therapy. In advanced stages, serious complica-

Diabetic maculopathy is the most frequent cause of decreased vision encountered

**256**

Early detection of DR depends on educating DM subjects, as well as their families, friends, and health care providers about the importance of regular eye examination. This holds true for asymptomatic subjects as well.

Initial ophthalmological examination in a patient with suspected/confirmed DR should include the following:


A variety of imaging techniques are useful to detect, classify and monitor DR, as well as efficacy of treatment: fundus photography, fluorescein angiography, optic coherence tomography (OCT) and OCT angiography.
